Scripps also plans to cement an affiliation with Houston’s MD Anderson Cancer Center by building a stand-alone oncology building near Mercy Hospital and adding onto its existing radiation therapy center across the street from Green.

Chris Van Gorder, Scripps’ chief executive, the plan is intended to fully address state laws which require all hospitals to meet stringent earthquake standards by 2030 or cease operation.

“It’s probably the biggest and most inclusive initiatives Scripps has seen in its history,” Van Gorder said.

These projects remain on the horizon, however. None of them break ground until 2021 and some may not finish until close to 2030. And, while it might seem like spending nearly $3 billion would mean that Scripps is doubling or tripling its current number of patient beds, that’s not the case.

Though specific bed counts for the new buildings are not yet available, Van Gorder said they would be roughly similar to those in existing buildings. This is because, he said, more and more hospitals services are delivered on an outpatient basis, meaning that fewer beds per capita will be needed in the future.

Van Gorder stressed that all schedules are tentative and subject to revision.

“We expect to be able to do this, but if the conditions change, the plan will change as well,” Van Gorder said.

Funding is the largest variable in this construction equation. Van Gorder said that Scripps is counting on significant fundraising, as it has for other recent projects, to make the numbers pencil out. Scripps also plans to borrow against future revenue and to spend from its reserves which are listed at more than $2 billion on the system’s most recent financial disclosures to bondholders.

Politics can also get in the way.

Much about how health insurance companies and federal programs such as Medicare pay hospitals is currently in flux, and big changes could force Scripps to reconsider its project list. The most recent example, Van Gorder said, is the current GOP tax proposal which calls for elimination of tax-exempt status for “private activity” bonds often used by nonprofits like Scripps to finance hospital projects.

That proposal could add extra cost. Though it’s hard to say exactly what the impact would be without a full and approved proposal, Van Gorder said that even a 0.5 percent increase in financing costs on $1 billion in borrowing would increase costs $150 million over 30 years.

“And that’s if it’s only half a point. This is not insignificant for California hospitals since the regulations and approval process make our hospital construction more expensive than any other state in the country,” Van Gorder said.

Scripps building boom comes after many hospitals across the region have already been rebuilt or significantly upgraded. It’s a trend that goes far beyond San Diego.

“Projects like this do signal a robustness in the ambitions of hospitals and hospital systems to modernize their facilities,” said Niall Brennan, president of the Health Care Cost Institute in Washington.

In San Diego, all of the new facilities that have opened in recent years have had private rooms with spacious designs that look more like hotels than traditional hospitals. That’s been the case, Brennan said, in other big cities. While patients may like the look and feel of new facilities, the long-term debt that they generate is substantial.

“If people are really paying attention, they should be outraged because somebody’s got to pay for these new facilities, and who will pay will be employers and consumers in the form of higher premiums and copays and deductibles,” Brennan said.

But Van Gorder said his facilities plans are driven in large part by state seismic mandates and a need to become more efficient as reimbursement becomes more difficult. He said financing this slate of projects does not assume future price increases.

“I don’t think, looking forward, we are going to reasonably have the ability to increase charges,” Van Gorder said.

The new seven-story tower slated for La Jolla will include a women’s health center, labor and delivery, post-partum beds, an obstetrical surgery area and a neonatal intensive care unit. Plans are to build it on a currently-vacant triangular parcel directly adjacent to the $456 million Prebys Cardiovascular Institute which opened in 2015. Once the project is complete, much of the existing hospital will be torn down.

That’s also the case at Mercy. Plans call for the hospital’s main tower, which opened in 1966, to be razed once a new replacement tower is built just to the south of the existing hospital’s trauma and emergency department.

For now, Scripps’ smaller hospitals in Chula Vista and Torrey Pines are getting retrofits rather than total reworking. Van Gorder said those facilities need less seismic work overall, with larger overhauls likely needed in the future.

“We will ultimately, I believe, will need to replace those facilities, but it may not be in this timeframe,” Van Gorder said.

CAPTION

Why aren't Americans getting flu shots?

Why aren't Americans getting flu shots?

CAPTION

In its strongest public outreach to date, city and county leaders urged the public to do everything they can to help end the region's historic hepatitis A outbreak.

In its strongest public outreach to date, city and county leaders urged the public to do everything they can to help end the region's historic hepatitis A outbreak.